Distance Learning Essay

TREATMENT UPDATE

Recent Advances in Tape Slings for Female Urinary Stress Incontinence
Red Alinsod, MD, FACOG, FACS
South Coast Urogynecology, Laguna Beach, CA

Sling therapy is the enhanced surgical support of the urethra. In this article, the history of the use of slings for the surgical treatment of female urinary stress incontinence is reviewed, and the usual surgical routes for retropubic (transvaginal) or transobturator tape passage are described. The latest innovation in sling therapy is the use of minislings, which are short tape mesh implants inserted through a single vaginal incision; these slings may be placed in an office setting. Outcomes data are either lacking or suggest a considerable decrement of effectiveness of unstabilized minislings over full-length slings; however, the short-term efficacy of a stabilized, adjustable minisling is 97%. These results suggest benchmark effectiveness associated with full-length slings in a less invasive device that also has the capability of short-term adjustability. [Rev Obstet Gynecol. 2009;2(1):46-50]
© 2009 MedReviews®, LLC

Key words: Minisling • Urinary stress incontinence • Retropubic sling • Transvaginal tape • Subfascial or transobturator sling • Suburethral sling

rodynamic stress incontinence (USI) is the leakage of urine through an incompetent urethra in the absence of a detrusor contraction.1 The purest symptom of USI is urinary loss upon raising intra-abdominal pressure, as in coughing. Ten percent of middle-aged women report weekly incontinence,2 although only 1 in 1000 women undergo curative surgery. USI may be complicated by intrinsic sphincter deficiency (ISD), detrusor overactivity or voiding disorder, or pelvic organ prolapse. USI is amenable to physical therapy and to surgery. Drug therapy to remedy a structural defect has been understandably disappointing. Bulking agents have a role in treating women with ISD, those who have

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